ContactServicesEndodonticsOrthodonticsPeriodonticsOral SurgeryPediatrics, EDIT1. Confirm LocationWe've determined that this is the closest Refresh Dental office to your location.Would you like to make a new patient appointment request at:, Location , Owned and Operated by:Hours *Please be advised that this does not confirm an actual appointment.YesNo2. Who is this exam for?Are you an existing patient?YesNo Call Are you 18 years of age or older?YesNo Please Call 3. Select a Day and TimePrimary reason for your visit?CheckupCosmeticDenturesBroken ToothTooth PainOtherRequest Date Request Time : HH MM AMPM Full Name*Phone Number*Secondary Phone NumberEmail Address* Do you have insurance?YesNoEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.